=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306459318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASTERCARE HOMEHEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2020
-----------------------------------------------------
Last Update Date | 09/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4370 KUKUI GROVE ST STE 106
-----------------------------------------------------
City | LIHUE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96766-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-246-9116
-----------------------------------------------------
Fax | 808-246-9232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1314 S KING ST STE 424
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-597-1564
-----------------------------------------------------
Fax | 808-597-1565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ANWAR KAZI
-----------------------------------------------------
Credential | BSCE
-----------------------------------------------------
Telephone | 808-597-1564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------